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Formative Research on Medical

Tourism in Thiruvananthapuram District*

Project No. 6098

Srinivasan Kannan PhD1

Additional Professor

Achtutha Menon Centre for Health Science Studies

Sree Chitra Tirunal Institute for Medical Sciences and

Technology

1 PRINCIPAL INVESTIGATOR FOR THE INTERNALLY FUNDED PROJECT SUPPORTED BY SCTIMST.

ORDER NO. DIR/INT.PROJ/SCTIMST/JUNE 2014 DT 17.09.2014

* IN CONSULTATION WITH DR. MARGRET FRENZ (CONSULTANT)

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Contents

1. Background .................................................................................................................... 3

a. Foreign Tourist Arrivals in India .................................................................................. 8

b. Objective ........................................................................................................................ 8

c. Participants ................................................................................................................ 8

d. Sampling .................................................................................................................... 8

2. Methodology .................................................................................................................. 9

a. Inclusion Criteria ......................................................................................................... 9

b. IEC clearance ............................................................................................................. 9

c. Funding ...................................................................................................................... 9

d. Specialties treated .................................................................................................... 13

e. Cost and duration ..................................................................................................... 14

f. Problems faced by the industry ................................................................................ 14

3. Discussion and conclusion ........................................................................................... 14

4. References .................................................................................................................. 15

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1. Background

Due to globalization and increasing demand for health services made developing countries

like India which has good infrastructure and services as an attractive destination for low cost

health services for the tourists from developed countries (Mochi P, Shetty N and Vohoniya D,

2013).

Patients from developed countries travel to India to avoid waiting time for medical

procedures for common ailments (Gupta AS, 2008). Along with the modern medicine, India

has become a destination in the world for alternative medicine such as Yoga (Trivedi, M,

2013).

There are also benefits for the visitors/ patients in terms of money and no waiting for the

services. Many at times people get more choices for treatment. (Smitha et al. 2011)

To attract international clients for Medical Tourism, hospitals and clinics in India use variety

of messages (Valorie et.al 2011).

In Europe, patients avail medical treatments either as a citizen of EU in other member state

for reimbursement or pay out of pocket while accessing dental, cosmetic and elective

surgeries. The outcomes depend on the settings and procedures (Lunta and Carrerab, 2010).

This is some extending true in India. Some of the European clients have insurance coverage

and some pay on their own.

The cross border mobility for healthcare depends on availability, affordability, familiarity,

quality and insurance coverage (Glinos et al. 2010)

There are frameworks to analyse the interrelated concepts and dimensions for cross-border

mobility of patients (Legido-Quigleyaet al. 2012).

Medical Tourism now is better understood by its alternative terminology, ‘transnational

health care’ (Mainila et al. 2012)

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Table 1 Foreign Tourist Arrivals in India according to purpose of visit 2009-

2013Year

It has increased from5 million to 7 million

Figure 1 FTAs (Numbers)

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Figure 2 Medical Treatment (Numbers)

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Table 2 FTA according to purpose 2013

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a. Foreign Tourist Arrivals in India

Foreign Tourists arrivals reduce from the month of April to September every year In terms of

the ranks of foreign tourist visiting India, USA tops. UK is in 2nd Position, while Russia is in

5th, followed by Canada 6th, Germany 7th, and France 8th. (In terms of source of countries

for FTAs in India during 2013).

Methodology

b. Objective

To understand the patterns of Medical Tourism in Thiruvananthapuram district

c. Participants

The service providers of Medical Tourism packages in Thiruvananthapuram District.

(The institutions providing such services in Trivandrum - Kovalam and Varkala. )

d. Sampling

A list of Ayurvedic Health resorts from Poovar, Kovalam and Varkala was generated from -

Kerala tourism website, the hotelier association and location specific websites such as

kovalam.com and other sources. In the final list there were 113 resorts first, a number

between 1 and 10 was randomly picked up from random table.

Then 113 was divided by 25 = 5 (sample size) (approximately). The resort with the random

number was first picked up from the first number, every fifth resort was included. The

process continued until we reached the 25th resort.

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2. Methodology

Number of persons interviewed was 24. Interviews were conducted among the administrators

of Medical Tourism services in selected institutions.

a. Inclusion Criteria

The institutions providing Medical Tourism Packages

The respondent was briefed about the informed consent process before collecting the data.

Data was collected only from those who consented to participate

b. IEC clearance

Institute Ethics committee of Sree Chitra Tirunal Institute for Medical Sciences and

Technology, given clearance to conduct the study.

Reference Number:

SCT/IEC-572/MARCH – 2014 Dt. 19-03-14

c. Funding

This is funded by Sree Chitra Tirunal Institute for Medical Sciences and Technology under

the Internal Research funding for the faculty members of the institute.

Order No. Dir/INT.PROJ/SCTIMST/June 2014 Dt 17.09.2014

Principal Investigator: Dr. Srinivasan Kannan, Additional

Professor, Achutha Menon Centre for Health Science Studies, SCTIMST

External Consultant: Dr. Margret Frenz, Lecturer in Global History at St Cross College,

University of Oxford

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Table 3 Profile of the Ayurvedic Resorts

Table 4 Specialties

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Table 5 Number of Rooms (5 to 22)

Missing 5

Total 22

Table 6 No of treatment rooms( 2 to 16)

Table 7 Number of Doctors (N=22)

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Table 8 Number of Therapists (N=22)

Fig 3 Season and Off-season for tourists to visit

Season for Tourism August to October, October to March Off-Season April to July

*It is only a representation not the actual number

Table 9 duration of stay (N=22)

Table 10 Countries from where the tourists are visiting (N=22)

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Table 11 Promotional Strategies (N=22)

d. Specialties treated

• Treatment for Arthritis, Spinal Disorders, Back pain, Migraine, Paralysis, Respiratory,

Infertility, obesity, Parkinson, Joint pains, skin diseases, neurological problems,

Gynaecological problems , Infertility, Respiratory problems, CVD, stress, sports related

problems, digestive disorders, Mental stress relief, Renal treatment, Stone etc.

Gastroenterology, stomach, Lungs, Spine and neck, Rejuvenation, Body purification,

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longevity, anti-aging, Massage, Eye treatments, Steam bath, cholesterol control, BP control,

Facial treatments, Spa, Beauty treatments, Revitalize, Marma, diabetic, dentistry,

Panchakarma, Poorvakarma, Paschathkarma

e. Cost and duration

In an average 20 USD per each treatment.

There are 34 types of treatments Packages varies from 3 days to 21 days

f. Problems faced by the industry

Sri Lanka emerging as a competitor – providing services at half of the prices Economic

slowdown in Europe and Ebola affected the industry Strict visa regulation prevented the

medical tourists from visiting India (High)Tax structure of the government affected the

business Wellness centres undermined the ayurveda, by adversely affecting ayurvedic

treatments European tussle on qualification and clinical trial for medicines affected the

business

“The western nations have already taken over Yoga from India and not allowing Indian

trainers to train in the resorts. “

“If the trend continues like this even Ayurveda will be administered by the westerners. “

The power politics in terms of standards and examinations in the western Universities affect

the Ayurveda in long run.

3. Discussion and conclusion

Medical Tourism in Ayurveda is a growing industry.

The following problems faced by the resorts need attention: poor government support on

creating good infrastructure, non-supportive policy for medical tourism, mixing up Ayurveda

with wellness and massage. Many of the tourists are from European countries. The stringent

examination in the University system does not allow the Ayurvedic physicians to go to

Europe for training and practice.

This in turn affects the Ayurveda in India.

There are some resorts offer hands on training to western trained physicians and therapists at

their clinics.

The seasonal nature of this industry affects the livelihood of the therapists and other

peripheral workers during off seasons.

Mushrooming of massage centres, wellness clinics, and home stays affect the business

during last couple of years.

In addition, Sri Lanka creates a tough competition in the industry needs to addressed.

The recent ban on alcohol had affected the centres as many of their ingredients contain

alcohol.

The government limited the quantity of alcohol to be held by ayurvedic centres as per the

new liquor policy.

This lead to the therapists and ayurvedic physicians regularly report at the local police

station.

This discourages women workers to work in this industry.

In the recent months harassment by the police and excise departments are on the raise.

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4. References

Crooks VA, Turner L, Snyder J, Johnston R, Kingsbury P. Promoting medical tourism to

India:

Messages, images, and the marketing of international patient travel. Social Science &

Medicine 72 (2011) 726-732

Glinos IA, Baeten R, Helble M, Maarse H. A typology of cross-border patient mobility.

Health &Place. 16(2010) 1145–1155

Gupta AS. Medical tourism in India: winners and losers. Indian Journal of Medical Ethics.

5(1); 2008:4-5.Accessed from http://www.issuesinmedicalethics.org/pdfs/161ed04.pdf

Accessed on 30 November 2013.

India Tourism Statistics 2013, http://tourism.gov.in/writereaddata/CMSPagePicture/file/

marketresearch/publications/IndiaTourismStatics2013_1.pdf accessed on 19/06/2015

Legido-Quigley H, Glinos IA, Baeten R, McKee M, Busse R. Analysing arrangements for

cross border mobility of patients in the European Union: A proposal for a framework. Health

Policy. 108 (2012) 27– 36

Lunta N, Carrerab P. Medical tourism: Assessing the evidence on treatment abroad.

Maturitas. 66 (2010) 27–32

Mainil T, Loon FV, Dinnie K, Botterill D, Platenkamp V, Meulemans H. Transnational

health care: From a global terminology towards transnational health region development.

Health Policy. 108(2012) 37– 44

Mochi P, Shetty N, Vahoniya D. Medical tourism - destination India. Journal Commerce and

Management 2013 Vol. 2 No. 3 pp. 29-39. Accessed from http://www.cabdirect.org/

abstracts/20133256173.html;jsessionid=ED5D5C069678DA01963AA067ACD176AF

Accessed on 30 November 2013.

Smitha R, Álvareza MM, Chandab R. Medical tourism: A review of the literature and

analysis of a role for bi-lateral trade. Health Policy. 103 (2011) 276– 282

Trivedi, M. (2013). Medical Tourism in India. PHILICA.COM Article number 387. Accessed

from

http://philica.com/display_article.php?article_id=387 Accessed on 30 November 2013.

Gupta AS. Medical tourism in India: winners and losers. Indian Journal of Medical

Ethics. 5(1); 2008:4-5.Accessed from

http://www.issuesinmedicalethics.org/pdfs/161ed04.pdf Accessed on 30 November

2013.

Mochi P, Shetty N, Vahoniya D. Medical tourism - destination India. Journal

Commerce and Management 2013 Vol. 2 No. 3 pp. 29-39. Accessed from

http://www.cabdirect.org/abstracts/20133256173.html;jsessionid=ED5D5C069678DA

01963AA067ACD176AF Accessed on 30 November 2013.

Trivedi, M. (2013). Medical Tourism in India. PHILICA.COM Article number 387.

Accessed from http://philica.com/display_article.php?article_id=387 Accessed on 30

November 2013.